Stereotactic Radiosurgery Practice Patterns for Brain Metastases in the United States: A National Survey

Background: Stereotactic radiosurgery (SRS) has emerged as an important modality for the treatment of intracranial metastases. There are currently few established guidelines delineating indications for SRS use and fewer still regarding plan evaluation in the treat- ment of multiple brain metastases. Methods: An 18 question electronic survey was distributed to radiation oncologists at National Cancer Institute (NCI) designated cancer centers in the US (60). Centers without radiation oncologists were excluded. Physicians who indicated that they do not prescribe SRS were excluded from the remaining survey questions. Sign test and Chi-square test were used to determine if responses differed significantly from random distribution. Results: 116 of the 697 radiation oncologists surveyed completed the questionnaire, representing 51 institutions. 62% reported treating patients with brain metastases using SRS. Radiation oncologists prescribing SRS most commonly treat CNS (66.2%) and lung (49.3%) malignancies. SRS was used more frequently for \u3c10 brain metastases (73.7%; p\u3c.0001) and whole brain radiation therapy (WBRT) for \u3e10 brain metastases (82.5%; p\u3c.0001). The maximum number of lesions physicians were willing to treat with SRS without WBRT was 1-4 (40.4%) and 5-10 (42.4%) (p\u3c.0001 compared to 11-15, 16-20 and no limit). The most important criteria for choosing SRS or WBRT were number of lesions (p\u3c.0001) and performance status (p=.016). The most common margin for SRS was 0 mm (49.1%; p=.0021). The most common dose constraints other than critical structure was conformity index (84.2%) and brain V12 (61.4%). The LINAC was the most common treatment modality (54.4%) and mono-isocenter technique for multiple brain metastases was commonly used (43.9%; p=.23). Most departments do not have a policy for brain metastases treatment (64.9%; p=.024). Conclusions: This is one of the first national surveys assessing the use of SRS for brain metastases in clinical practice. These data highlight some clinical considerations for physicians treating brain metastases with SRS. Summary: This is among the first national surveys to assess the use of SRS for brain metastases in clinical practice. Specifically, radiation oncologist reported increasingly using SRS instead of WBRT for treating \u3c10 metastases, with the LINAC being the most common modality. Further, treatment parameters considered the most important included 0 mm margins, conformity index, brain V12, and mono- isocenter technique for multiple brain metastases. These results may provide context regarding the use of SRS for brain metastases in clinical practice

Chapter 2: Dumbart jen jen – first steps

This chapter is written as a conversation (held in December 2016) between David Palmer (host), Ingrid Cumming, Jennie Buchanan (both Research Associates of the project) and Gideon Digby (President of Wikimedia Australia), who introduce themselves and go on to discuss their roles in the Noongarpedia adventure

Awareness, Discovery, Becoming, and Debriefing: Promoting Cross-Cultural Pedagogical Understanding in an Undergraduate Education Program

This article discusses the first phase of an action research project aimed at identifying a collaborative and collective response to the need to prepare student teachers to work in diverse school contexts. The research brought together university researchers, community and cultural institutions, professional associations, school boards, and government and civil organizations to design a Diversity Institute for integration into the teacher preparation program at the University of Alberta. Student teachers’ responses to the Diversity Institute suggest that although a few participants were able to develop new understandings of themselves and others and to effect changes in their pedagogical practices, many remained at a shallow level of awareness about the complexities of diversity and difference. Reflections on the first phase of the Institute point to the underlying dynamics of learning and unlearning that are at work in becoming a teacher and the need for time and space for a deeper engagement with diversity in the teacher education program.Cet article présente la première phase d’un projet de recherche action visant l’identification d’une réponse collaborative et collective au besoin de préparer les étudiants en pédagogie à travailler dans divers contextes scolaires. La recherche a impliqué la collaboration de chercheurs universitaires, d’instituts communautaires et culturels, d’associations professionnelles, de conseils scolaires et d’organisations gouvernementales et civiles, dans la conception d’une série d’ateliers et de présentations (nommée Diversity Institute 2008) qui a ensuite été intégrée au programme de pédagogie à l’Université de l’Alberta. La réaction des étudiants en pédagogie qui ont participé aux ateliers et aux présentations indique que, même si quelques participants ont pu développer de nouvelles connaissances sur eux-mêmes et les autres, et qu’ils ont réussi à modifier leurs pratiques pédagogiques, plusieurs n’ont acquis qu’une connaissance superficielle des complexités de la diversité et la différence. Les réflexions sur la première phase de Diversity Institute ont fait ressortir, d’une part, les rapports dynamiques et sous-jacents d’apprentissage et de désapprentissage qui accompagnent la formation des étudiants en pédagogie et, d’autre part, le besoin de temps et d’espace au sein du programme de pédagogie pour permettre une appréciation approfondie de la diversité

Chapter 7: Gnulla Koorliny – Working with other groups

The success of the Noongarpedia Project has depended on forging relationships with groups already active in the Noongar knowledge space. Perhaps the most important relationships were built with Storylines (State Library of Western Australia) and Wikimedia Australia. Organisations such as Noongar Boodjar Language Cultural Aboriginal Corporation, the South West Aboriginal Land and Sea Council (SWALSC) and South Coast Natural Resource Management were also important, particularly in offering support in identifying key resources and offering expert advice on Noongar language and knowledge

Chapter 3: Noongar boordier gnulla katitjin – The influence of Noongar knowledge.

Despite the history of settler colonisation and state control (Attwood, 1989), where Indigenous people and their knowledge has been ‘classified, excluded, objectified, individualised, disciplined, and normalised’ (Best and Kellner), it is important to recognise that this is not the complete story. Western science and knowledge systems have had a long history of interrelationship with Australian Indigenous cultural life and systems. As bell hooks (1992) put it when describing the influence of African-Americans on US culture (see also Todd Boyd, 1997), even in the worst circumstances of domination, blacks have an ability to manipulate, shape and open up exchanges with white knowledge systems

Chapter 8: Bulla djandanginy – Challenges and tensions

Some of the difficulties confronting a project like this are the consequence of a history of colonisation and institutional oppression of Aboriginal people in south-west Western Australia (Haebich, 1992; 2000; Haebich and Morrison, 2014). It is a history characterised by land theft (Reconciliation, n.d.); a history in which only a minority of the original, Indigenous population survived the first decades of colonisation (Green, 1984; Swain, 1993; Aboriginal Legal Service, 1995), and a history in which that population was then subject to a period of discriminatory legislation and the denigration of Noongar language and culture which lasted well into the late twentieth century (Haebich, 2000). More recently, Noongar language and knowledge has increasingly been celebrated in mainstream cultural life – festivals, theatre, music, literature, exhibitions and the like, along with numerous examples of general urban and street signage and, of course, Welcomes to Country. It has become a major denomination in the currency of identity and belonging in this part of the world

Determining the probability of cyanobacterial blooms: the application of Bayesian networks in multiple lake systems

A Bayesian network model was developed to assess the combined influence of nutrient conditions and climate on the occurrence of cyanobacterial blooms within lakes of diverse hydrology and nutrient supply. Physicochemical, biological, and meteorological observations were collated from 20 lakes located at different latitudes and characterized by a range of sizes and trophic states. Using these data, we built a Bayesian network to (1) analyze the sensitivity of cyanobacterial bloom development to different environmental factors and (2) determine the probability that cyanobacterial blooms would occur. Blooms were classified in three categories of hazard (low, moderate, and high) based on cell abundances. The most important factors determining cyanobacterial bloom occurrence were water temperature, nutrient availability, and the ratio of mixing depth to euphotic depth. The probability of cyanobacterial blooms was evaluated under different combinations of total phosphorus and water temperature. The Bayesian network was then applied to quantify the probability of blooms under a future climate warming scenario. The probability of the "high hazardous" category of cyanobacterial blooms increased 5% in response to either an increase in water temperature of 0.8°C (initial water temperature above 24°C) or an increase in total phosphorus from 0.01 mg/L to 0.02 mg/L. Mesotrophic lakes were particularly vulnerable to warming. Reducing nutrient concentrations counteracts the increased cyanobacterial risk associated with higher temperatures

Maternal complications in pregnancy and childbirth for women with epilepsy: time trends in a nationwide cohort

Objective: Obstetric trends show changes in complication rates and maternal characteristics such as caesarean section, induced labour, and maternal age. To what degree such general time trends and changing patterns of antiepileptic drug use influence pregnancies of women with epilepsy (WWE) is unknown. Our aim was to describe changes in maternal characteristics and obstetric complications in WWE over time, and to assess changes in complication risks in WWE relative to women without epilepsy. Methods: This was a nationwide cohort study of all first births in the Medical Birth Registry of Norway, 1999–2016. We estimated maternal characteristics, complication rates, and risks for WWE compared to women without epilepsy. Main maternal outcome measures were hypertensive disorders, bleeding in pregnancy, induction of labour, caesarean section, postpartum hemorrhage, preterm birth, small for gestational age, and epidural analgesia. Time trends were analyzed by logistic regression and comparisons made with interaction analyses. Results: 426 347 first births were analyzed, and 3077 (0.7%) women had epilepsy. In WWE there was an increase in proportions of induced labour (p<0.005) and use of epidural analgesia (p<0.005), and a reduction in mild preeclampsia (p = 0.006). However, the risk of these outcomes did not change over time. Only the risk of severe preeclampsia increased significantly over time relative to women without epilepsy (p = 0.006). In WWE, folic acid supplementation increased significantly over time (p<0.005), and there was a decrease in smoking during pregnancy (p<0.005), but these changes were less pronounced than for women without epilepsy (p<0.005). Conclusions: During 1999–2016 there were important changes in maternal characteristics and complication rates among WWE. However, outcome risks for WWE relative to women without epilepsy did not change despite changes in antiepileptic drug use patterns. The relative risk of severe preeclampsia increased in women with epilepsy.publishedVersio

Digital Business in der Praxis. Modell, Analyse und Handlungsfelder

Der Beitrag beschäftigt sich mit der digitalen Transformation von Organisationen. Er zeigt auf der Basis der Beiträge dieses Sammelbands und der angeführten Ergebnisse eigener empirischer Studien, welche Veränderungsprozesse in welcher Tiefe und in welchem Feld beobachtet werden können. Anhand eines maturitätsorientierten Analysemodells zum digitalen Business werden die Transformationsprozesse in den einzelnen Fallstudien zuordenbar. Die Beiträge dieses Sammelbandes reflektieren die Annahme, dass sich die digitale Transformation in ihren unterschiedlichen Ausprägungen grundsätzlich intensiviert. Besonders deutlich wird dies für Prozesse der Automatisierung in der Industrie und auch für den Begleitprozess im Bereich Human Resources, die den Change strategisch begleiten und in einer neuen Art unterstützen